The management of diagnostic uncertainty and decision-making in genetics case conferences

Authors

  • Olga Zayts University of Hong Kong
  • Srikant Sarangi Aalborg University
  • Stephanie Schnurr University of Warwick

DOI:

https://doi.org/10.1558/cam.18433

Keywords:

activity analysis, decision-making, (diagnostic) uncertainty, evidence, genetics case conferences, role-relationships, team talk

Abstract

In this paper we examine one type of intraprofessional collaborative activity, namely case conferences in a specialist genetics clinic. Our specific focus is on how clinical geneticists manage decision-making through team talk in the event of diagnostic uncertainty which is mainly attributable to limitations in the current state of genomic knowledge, ‘uncertain significances’ associated with genetic test results, and a lack of information/ evidence pertaining to cases under discussion. The case conference then becomes a means to minimise the uncertainty and arrive at decisions that optimise the significance of the results in terms of clients’ life trajectories. Adopting theme-oriented activity analysis, we examine video-recorded data from five case conferences in Hong Kong. Beginning with a prototypical structural mapping of the case conference activity type, our analysis focuses on what we call ‘uncertain cases’. Our findings highlight three discourse types constitutive of team talk: pedagogic talk, diagnostic talk and decisional talk. In paying particular attention to how uncertainty is formulated and negotiated, we suggest that access to and assessment of different kinds of evidence as well as the activity-specific expert role-positions of the participants are crucial with regard to establishing a correct diagnosis and/or striving towards a minimisation of current uncertainties.

Author Biographies

Olga Zayts, University of Hong Kong

Olga Zayts is assistant Professor at the University of Hong Kong. She leads the Health Communication research Cluster at the Centre for the humanities and Medicine. Her research interests focus on interactional approaches to professional communication in healthcare settings, in particular in genetic counselling and prenatal screening in Hong Kong. She has published widely on the issues of information-giving vis-à-vis advice-giving and decision-making in genetic counselling, politeness, identity and intercultural communication.

Srikant Sarangi, Aalborg University

Srikant Sarangi is Professor and Director of the Danish Institute of Humanities and Medicine (DIHM). his research interests include language and identity in public life, institutional and professional discourse, quality of life and risk communication in genetic counselling, HIV/aIDS, telemedicine, general practice and palliative care, intercultural pragmatics, racism and ethnicity in multicultural societies. he is the author/editor of 12 major book-length publications and more than 200 book chapters and journal articles in leading discourse and communication journals.

Stephanie Schnurr, University of Warwick

Stephanie Schnurr is Associate Professor at the Centre for applied Linguistics at Warwick University, UK. her research interests are professional and medical communication. She has researched and published widely on various aspects of leadership discourse, gender, the multiple functions and strategic uses of humour, politeness and impoliteness, identity construction, the role of culture, decisionmaking and advice-giving and other aspects of workplace discourse in a range of professional and medical contexts.

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Published

2017-02-08

How to Cite

Zayts, O., Sarangi, S., & Schnurr, S. (2017). The management of diagnostic uncertainty and decision-making in genetics case conferences. Communication and Medicine, 13(1), 37–50. https://doi.org/10.1558/cam.18433